Bone plates with intraoperatively tapped apertures

ABSTRACT

Systems, including apparatus, methods, and kits, for selectively tapping apertures of bone plates, to form threaded apertures during installation of the bone plates (i.e., intraoperatively).

CROSS-REFERENCE TO PRIORITY APPLICATION

[0001] This application is based upon and claims the benefit under 35U.S.C. § 119(e) of U.S. Provisional Patent Application Ser. No.60/480,529, filed Jun. 20, 2003, which is incorporated herein byreference in its entirety for all purposes.

INTRODUCTION

[0002] The human skeleton is composed of 206 individual bones thatperform a variety of important functions, including support, movement,protection, storage of minerals, and formation of blood cells. Thesebones can be grouped into two categories: the axial skeleton, and theappendicular skeleton. The axial skeleton consists of 80 bones that makeup the body's center of gravity, and the appendicular skeleton consistsof 126 bones that make-up the body's appendages. The axial skeletonincludes the skull, vertebral column, ribs, and sternum, among others,and the appendicular skeleton includes the long bones of the upper andlower limbs, and the clavicles and other bones that attach these longbones to the axial skeleton, among others.

[0003] Bones of the skeleton may become fractured in response to trauma.To ensure that the skeleton retains its ability to perform its importantfunctions, and to reduce pain and disfigurement, fractured bones shouldbe repaired promptly and properly. Typically, fractured bones aretreated using fixation devices, which reinforce the fractured bones andkeep them aligned during healing. Fixation devices may take a variety offorms, including casts for external fixation and bone plates forinternal fixation, among others. Casts are minimally invasive, allowingreduction and fixation of simple fractures from outside the body. Incontrast, bone plates are sturdy internal devices, usually made ofmetal, that mount directly to the bone adjacent the fracture.

[0004] Bone plates may be used to repair a fracture, as follows. First,a surgeon selects an appropriate plate. Second, the surgeon reduces(sets) the fracture. Finally, the surgeon fastens the plate to oppositesides of the fracture using suitable fasteners, such as screws and/orwires, so that the bone is fixed in position. The mounted plate may beleft in place permanently, or it may be removed after the bone hashealed sufficiently.

[0005] Bone plates typically include a plurality of apertures forreceiving fasteners such as bone screws. These apertures may benonthreaded or threaded.

[0006] Nonthreaded apertures may be used to provide compression at aselectable angle of fastener placement. Specifically, a bone screwinserted through a nonthreaded aperture will thread into the bone butnot the bone plate. Thus, the screw will turn without limitation untilthe bone plate and bone are brought into contact, or compressed.Furthermore, variable angle screws may be used in conjunction withnonthreaded apertures. This may allow the angle with which the screwenters the bone to be chosen by the surgeon intraoperatively.

[0007] Threaded apertures, in contrast, may be used to lock the screwinto the plate and buttress the bone. Specifically, a bone screwinserted through a threaded aperture will thread into both the plate andbone. Thus, there may be a space between the plate and bone if the screwis threaded fully into the plate (such that the screw cannot turn anymore) before compression occurs between the bone and the plate. Thespace may have several advantages, such as facilitating healing bypreserving blood flow to the bone, and, in the case of a removable boneplate, reducing undesirable bonding of the plate to the bone. However, athreaded aperture typically limits the angle of installation of thescrew, since the threads provide a fixed orientation for engagementbetween the screw and the aperture. A fixed screw also may act as abuttress in the bone to reduce malunion due to bone resorption.

[0008] Bone plates are provided with nonthreaded or threaded aperturesbased on the best guesses of manufacturers regarding the most suitableapertures for a given indication. Thus, surgeons currently may belimited to using plates designed only for the most common fractures.However, although many fractures share common motifs, no two fracturesor bones are identical. In some cases, a surgeon may want a threadedaperture where a nonthreaded aperture is provided, or vice versa.Similarly, a surgeon may find it desirable to insert a screw through athreaded aperture, but at a specific angle that is not provided by aconventional bone plate.

SUMMARY

[0009] The present teachings provide systems, including apparatus,methods, and kits, for selectively tapping apertures of bone plates, toform threaded apertures during installation of the bone plates (i.e.,intraoperatively).

BRIEF DESCRIPTION OF THE DRAWINGS

[0010]FIG. 1 is a perspective view of a system for tapping bone platesintraoperatively, including an exemplary tap device being positioned fortapping an aperture of a bone plate while the bone plate is disposed ona surface of a bone, in accordance with aspects of the presentteachings.

[0011]FIG. 2 is a fragmentary perspective view of a distal portion ofthe tap device of FIG. 1.

[0012]FIG. 3A is a side elevation view of the tap device of FIG. 1.

[0013]FIG. 3B is a fragmentary side elevation view of selection portionsof the tap device of FIG. 1, particularly a tap portion of the tapdevice.

[0014]FIG. 3C is a sectional view of the tap device of FIG. 1, takengenerally along line 3C-3C of FIG. 3B.

[0015]FIG. 4 is a fragmentary side elevation view of another exemplarytap device for intraoperatively tapping an aperture of a bone plate, inaccordance with aspects of the present teachings.

[0016]FIG. 5 is a side elevation view of an exemplary bone screw thatmay be threadably engaged with a thread of an aperture intraoperativelytapped by the system of FIG. 1, in accordance with aspects of thepresent teachings.

[0017]FIG. 6 is a partially sectional view of the bone screw of FIG. 5placed into threaded engagement with a bone plate and bone, inaccordance with aspects of the present teachings.

[0018]FIGS. 7-12 are partially sectional views of exemplaryconfigurations of a bone plate, a bone, and bone screws created byperforming steps of a method of securing a bone plate to a bone, inaccordance with aspects of the present teachings.

[0019]FIG. 13 is a sectional view of an exemplary guide device clampedto a bone and a bone plate and defining a path through an aperture ofthe bone plate and into the bone, in accordance with aspects of thepresent teachings.

DETAILED DESCRIPTION

[0020] The present teachings provides systems, including apparatus,methods, and kits, for selectively tapping apertures of bone plates, toform threaded apertures during installation of the bone plates (i.e.,intraoperatively). These systems may allow a surgeon to chooseindependently between threaded and nonthreaded engagement with afastener for different apertures of the bone plates, so that eachfastener can be locked or not locked, respectively, to the plates.Moreover, these systems may allow the surgeon to choose the angle atwhich fasteners engage the bone plate and bone, by allowing theapertures to be tapped at selected angles.

[0021]FIG. 1 shows an exemplary system 10 for intraoperatively tappingan aperture(s) of a bone plate. The system may include, among others,(1) a tap device 12, (2) a bone plate 14 having one or more apertures16, and (3) fasteners to be received in tapped and/or nontappedapertures of the bone plate. The tap device may be used to form a threadin (to tap) any suitable number of the apertures of the bone plate. Eachaperture may be threaded or nonthreaded before intraoperative tapping isperformed. Furthermore, one or more (or all) apertures may besized/shaped to be tapped intraoperatively with the tap device, and oneor more (or no) apertures may be sized/shaped so that they cannot betapped readily with the tap device. In some embodiments, an aperture(s)may be formed and tapped in a bone plate by the tap device. In someexamples, the tap device may drill, ream, and/or tap bone underlyingeach aperture. Further aspects of tap devices and their uses in general,and tap device 12 and its uses in particular, are included below inSections I and III, among others.

[0022] The bone plate may be disposed on a bone 18, adjacent a suitablesurface of a bone. The suitable surface may be disposed on diaphysealbone (the shaft of the bone) and/or on metaphyseal bone (near an end ofthe bone). In some embodiments, intraoperative tapping adjacentmetaphyseal bone may be more suitable, due, for example, to the greatercomplexity in shape and/or breakage patterns in metaphyseal regions. Thebone may have at least one discontinuity, such as a fracture 20, whichmay be spanned by the bone plate, and/or the bone plate may strengthen abone lacking a discontinuity, among others. The bone plate may beconnected to the bone with suitable fasteners, such as one or more bonescrews 22 received in apertures of the bone plate and engaged withunderlying bone. In some examples, the fasteners may be positioned tosecure the bone plate to the bone on only one side or on opposing sidesof the discontinuity. In some embodiments, the fasteners may include awire, a clamp, a pin, and/or the like. In any case, the fasteners mayhold the bone plate in position on the bone provisionally, as the boneplate is being tapped at one or more apertures (and thenremoved/replaced), or for an extended period, such as during healing ofthe bone, among others.

[0023] The apertures to be tapped (i.e., threaded) in a plate, and theangles at which the apertures are tapped, may be selected. Selection maybe performed during surgery, based on x-ray (or other) imaging data,direct observation, trial fitting, and/or placement of a guide device,among others. The use of bone screws in conjunction with one or morethreaded apertures of a bone plate may allow at least a portion of theplate to be optionally positioned as a buttress, away from the bone.This may allow periostea, blood vessels, and/or the like to pass underthe plate without being pinched or damaged, possibly promoting fasterhealing. Positioning the plate slightly away from the bone further mayallow for some amount of natural settling and/or thickening (e.g.,through calcification) of the fractured bone. Accordingly, the presentteachings may provide greater flexibility in placement of bone screwsinto bone (such as metaphyseal bone), improved attachment of bone screwsto bone plates and/or to bone, and/or improved fixation and healing ofinjured bones, among others.

[0024] Further aspects of the present teachings are included in thefollowing sections, including, among others, (I) tap devices, (II)fasteners for tapped apertures, (III) methods of tapping apertures andof securing bone plates to bones, (IV) bone plates, (V) guide devices,(VI) kits, and (VII) examples.

[0025] I. Tap Devices

[0026] The systems of the present teachings provide tap devices. A tapdevice may include any structure that can be manipulated or operated toform a thread(s) in a bone plate, particularly while the bone plate isdisposed on a bone. The tap device also may be configured to form and/orfollow a hole in bone and/or in the bone plate, to widen a hole in thebone (and/or in the bone plate), and/or to reduce or draw out “chips”(i.e., bone and/or plate material removed by the tap device), amongothers. The tap device may be solid or may be partially or completelyhollow, for example, cannulated with an axial bore. The tap device mayinclude a tip portion, a reamer portion, a tap portion, and a drivenportion, among others. Any two or more of these portions may be coupledto one another in a fixed or a movable (such as a rotatable)relationship. In some examples, these portions may be formed integrallyas one piece, for example, as a tapping bit. In some examples, the tapdevice also may be configured to secure the bone plate to bone, such asa bone screw having a tapping structure included in the head of the bonescrew.

[0027] The tap device may be formed of any suitable material hard enoughto cut a thread in the bone plate and/or bone. Accordingly, the materialfor the tap device may be selected, for example, based on thecomposition of the bone plate. The material also may be rigid enough totransmit a torque from the driven portion of the tap device to the tapportion, and to remain generally nondeformed during tapping operations.Exemplary materials for the tap device may include metal, ceramic,plastic, composite, and/or the like.

[0028] The tip portion, also termed a guidance tip, may be disposed at aleading end (a distal region) of the tap device, to guide the tap deviceinto bone. The tip portion may help to stabilize the tap device and tohold it at a fixed angle relative to the bone, while tapping takesplace. Alternatively, or in addition, the tip portion may facilitatepenetrating the bone at a desired angle to produce a pilot hole in thebone, or may follow, widen, and/or deepen all or part of a preexistingpilot hole. The tip portion may be rigid enough not to be deformedsubstantially as it guides the tap portion to the bone plate.

[0029] The tip portion may have any suitable shape and size. The tipportion may be generally linear or may be nonlinear, such as helical orcurved. The tip portion may be generally cylindrical, having a smooth,textured, and/or contoured surface. A distal end region of the tipportion may be rounded, tapered, and/or or pointed, among others. Insome examples, the tip portion may include drilling structure, so thatthe tip portion also can form a hole in bone as the tip portion entersbone. In this case, the tip portion may include a cutting edge, ahelical channel, and/or a distal end region that is sharp, among others.The tip portion may have any suitable length, measured axially in thetap device. Generally, the tip portion may be at least as long as thetap portion, and may be at least about twice or three times as long asthe tap portion, among others. Furthermore, the tip portion may have alength selected according to the length of the shaft of a bone screw tobe used with the tap device. For example, the tip portion may have alength that is about as long as, shorter than, or longer than, thelength of the shaft of the bone screw to be placed in an aperture tappedby the tap device. In some embodiments, the tip portion may have alength of about 5 mm to 100 mm, with particular exemplary lengths ofabout 8 mm, 25 mm, and 50 mm, among others. The tip portion may have anysuitable diameter, generally a diameter less than the diameter of thetap portion and less than the crest-to-crest diameter of a threadedshaft of a fastener to be placed in an aperture tapped by the tapportion. In some examples, the diameter of the tip portion may be lessthan about one-half the diameter of the tap portion. In someembodiments, the tip portion may have a diameter of about 1.5 mm to 4.0mm, among others.

[0030] The reamer portion may be configured to widen a hole in bonefollowed and/or formed by the tip portion. Accordingly, the reamerportion may be included in the tip and/or tap portions or may bedisposed between the tip portion and the tap portion (such as adjoiningthe tap portion), among others. The reamer portion may taper from thetap portion toward the tip portion, and thus may have a generallyfrustoconical shape. The reamer portion may include one or more cuttingflutes extending, for example, generally axially on the tap device.

[0031] The tap portion may be used to form a thread in a bone plateaperture and/or in underlying bone. The tap portion may include anexternal thread or threaded region to guide cutting surfaces of the tapportion along a helical path to form an internal thread in the apertureand/or in the bone. The external thread or threaded region may have anysuitable number of thread segments arrayed generally axially, such as atleast one, two, three, or more. The tap portion may taper toward adistal section of the tap device (toward the tip portion), so that athread cut by the tap portion becomes shallower toward the tip portion,particularly in bone. Accordingly, the external thread/threaded regionof the tap portion may have flatter/shorter crests distally. The tapportion may include one or more cutting flutes intersecting the externalthread or threaded region, for example, extending axially on the tapdevice. The cutting flutes of the tap portion may abut cutting flutes ofthe reamer portion. In some examples, the tap portion (or an adjacent,proximal region of the tap device) may include a stop structure, such asa widened region or a transverse extension, that contacts the boneplate, to restrict excessive advancement of the tap portion through thebone plate. In some examples, the stop structure may have an adjustableaxial position.

[0032] The driven portion may be configured to be coupled to a driver sothat the tap device can be rotated. The driver may include any suitableturning mechanism, such as a power-driven or manually operated driver,and/or a manually operable lever or hand crank, among others. The drivenportion may include a shaft that extends proximally from the tapportion. The shaft may be cylindrical or noncylindrical. In someexamples, the shaft may be at least as long as the tap portion, or atleast twice as long, among others. The driven portion also may include,for example, a recess, a boss, a ridge, a groove, a thread, and/or abeveled/flattened section, among others, to facilitate engagement withthe driver.

[0033]FIGS. 2 and 3A-C show various views of tap device 12 from FIG. 1.The tap device 12 may include a tip portion 42, a reamer portion 44, atap portion 46, and a driven portion 48.

[0034] The tip portion 42 may be shaped to follow a pilot hole formed inbone. The tip portion 42 may include a rounded leading or distal end 50and a cylindrical following or proximal section 52. The tip portion maybe at least substantially or completely nonthreaded along its length.

[0035] The reamer portion 44 may flare outward as it extends away fromthe proximal section 52 of the tip portion. The reamer portion may abutthe tap portion 46 and may share a plurality of axial flutes 54 with thetap portion. An edge of each flute may define a cutting edge 56 wherethe flute meets the reamer portion (or the tap portion). The flutes alsomay extend into the tip portion and/or the driven portion.

[0036] The tap portion 46 may include a thread (or threads) 60 having aplurality of adjacent thread segments 62. The thread segments may begrouped into segment sets 64 separated by flutes 54 (see FIGS. 3B and3C). The thread may taper toward the tip portion. For example, distalthread segments, shown at 66, may be shorter and/or blunter thanproximal thread segments, shown at 68 (see FIG. 3B).

[0037] The driven portion 48 may include a spacer or shaft 70 and aninterface region 72 engaged by a driver (see FIG. 3A). The interfaceregion 72 may include an annular groove 74 and/or a planar recess 76,among others.

[0038]FIG. 4 shows another exemplary tap device 80 for intraoperativelytapping an aperture of a bone plate. Tap device 80 may include a tipportion 82 configured as a drill bit, to form a hole in the bone (and/orbone plate) before and/during tapping performed by a tap portion 84 ofthe tap device.

[0039] II. Fasteners for Tapped Apertures

[0040] The systems of the present teachings may provide fasteners to bereceived in tapped apertures, particularly apertures tapped by a tapdevice as described in Sections I and III. The fasteners, such as bonescrews, may include a head and a shank, each of which may be threaded ornonthreaded. The fasteners may be solid or partially or completelyhollow (i.e., cannulated with an axial bore)

[0041] The head may have any suitable size and structure. For example,the head may have any suitable diameter, generally at least as great as,or greater than the diameter of the shank. The diameter may correspondto the diameter of a tapped aperture, so that at least a portion of thehead fits closely into the tapped aperture. In some embodiments, thediameter of the head may be about 3 mm to 7 mm. The head may have anysuitable length, measured axially on the fastener. For example, thelength of the head may be less than, about the same as, or greater thanthe thickness of a bone plate for which the fastener is configured. Insome embodiments, the head may have length sufficient for a proximal (orintermediate) region of the head to be disposed in a tapped aperture ofthe bone plate and for a distal region of the head to be disposed inbone. In some examples, a proximal portion of the head may protrudeabove the bone plate when the fastener is fully installed. In someembodiments, the length of the head may be about 2 mm to 6 mm, amongothers. The head may include tool engagement structure, such as ahexagonal socket, a linear slot, a cruciform slot (with or without adeeper central depression), or the like, so that a tool can engage thehead and transmit torque to the head and shank. The head may include athread(s) extending along any suitable portion of its length. The threadmay be an external (male) thread configured to be threadably engagedwith the internal (female) thread of a tapped aperture and/or underlyingbone. The thread may include any suitable number of thread segmentsarrayed axially, generally at least two or more. In some examples, thehead may include at least three or at least four of such threadsegments. The thread segments may form a continuous thread and/or adiscontinuous thread (for example, interrupted by axial flutes).

[0042] The head also may include a shoulder region, a cap region, and/ortapping structure. The shoulder region may join the head to the shank.The shoulder region may taper toward the shank, for example, so that theshoulder region is generally frustoconical, or may be nontapered. Theshoulder region may be threaded or nonthreaded. A cap region may bedisposed proximally on the head. The cap region may be configured torestrict excessive advancement of the head through a tapped aperture.Accordingly, the cap region may be nonthreaded and/or may have anincreased diameter relative to an adjacent threaded region of the head.A tapping structure of the head may be configured to form and/or deepena thread in the bone plate and/or adjacent bone. The tapping structuremay be disposed, for example, at a leading (distal) section of the head.Exemplary tapping structure may include one or more flutes extendinggenerally axially relative to the head and intersecting a threadedregion thereof.

[0043] The shank may have any suitable size and structure. The shank mayhave any suitable length. For example, the shank may be shorter than, atleast as long as, or longer than the head. In some examples, the shankmay be at least twice as long as the head. In some embodiments, theshank may be about 5 mm to 100 mm in length, with particular exemplarylengths including 8 mm, 10 mm, 25 mm, 50 mm, or 70 mm, among others. Theshank may be long enough to extend through bone to an opposing bonecortex (for a bicortical fastener), to extend into cancellous bone,and/or to terminate in the cortex adjacent the bone plate (for aunicortical fastener). In some embodiments, the shank may be absent fromthe fastener. The shank may include a thread(s) disposed along anysuitable portion of the shank's length, such as at least substantiallythe entire length of the shank. The thread may have the same pitch as athread on the head or may have a different pitch, that is, a smaller orlarger pitch that is constant or variable. The shank may include tappingstructure configured to form and/or deepen a thread in the bone, such asin a pilot hole used to guide a tap device. The tapping structure may bedisposed, for example, at a leading (distal) section of the shank.Exemplary tapping structure may include one or more cutting flutesextending generally axially relative to the shank and intersecting athreaded region thereof.

[0044] Exemplary fastener sizes and pitches that may be suitable areincluded in the following patent application, which is incorporatedherein by reference: U.S. Provisional Patent Application Ser. No.60/548,685, filed Feb. 26, 2004.

[0045]FIG. 5 shows an exemplary bone screw 110 that may be threadablyengaged with an intraoperatively tapped aperture, for example, anaperture tapped with the tap devices of FIGS. 1-4. Bone screw 110 mayinclude a head 112 and a shank 114.

[0046] The head 112 may include any suitable structures. For example,the head may include a threaded region 116 extending over a majority ofthe length of the head. The threaded region 116 may include a thread118, which may be intersected by a plurality of flutes 120 to formtapping structures 122 each having a cutting edge 124. The head also mayinclude a cap region 126 forming a proximal region of the head.Furthermore, the head may include a tool engagement structure 128 forimparting torque to the bone screw, and a shoulder 130 forming atransition between the head and the shank.

[0047] The shank 114 may include any suitable structures. For example,the shank may include a threaded region 132 having a thread 134.Furthermore, a distal end of the shank may include one or more flutes136 to form one or more tapping structures 138 each having a cuttingedge 139.

[0048]FIG. 6 shows bone screw 110 disposed in threaded engagement with abone plate 140 and bone 142. A proximal region of the head 112 may bethreaded into a tapped aperture 144 of the bone plate, shown at 146. Thehead may be flush with the outer surface of the bone plate, disposedbelow this outer surface, or may project somewhat above the outersurface of the bone plate, as shown in the present illustration. Adistal region of the head may be threaded into a tapped cortical regionof the bone, shown at 148. The shank 114 may extend into anunderlying/opposing cortical, cancellous, and/or medullary region ofbone 142, for example, to be disposed in threaded engagement with thebone.

[0049] III. Methods of Tapping Apertures and of Securing Bone Plates toBones

[0050] The systems of the present teachings also provide methods oftapping apertures and/or of securing bone plates to bones. These methodsmay include, among other steps, any suitable combination of thefollowing steps, performed in any suitable order, any suitable number oftimes: (1) selecting a bone plate, (2) positioning the bone plate on abone, (3) connecting the bone plate to the bone, (3) forming a pilothole in the bone, (4) tapping an aperture(s) of the bone plate, and/or(5) placing a fastener(s) into the aperture(s). These methods may permita surgeon to determine, aperture by aperture, the spacing between theplate and bone, locked and nonlocked engagement of each fastener withthe bone plate, and/or the angle(s) with which fasteners extend throughthe bone plate and into bone. Thus, the methods described herein mayprovide surgeons with more options for installation of bone plates,which may lead to more secure and/or appropriate fixation of the plates.

[0051]FIGS. 7-12 show exemplary configurations of a bone plate, a bone,and bone screws that may be created by performing exemplary steps ofmethods of tapping apertures and/or of securing bone plates to bones.These configurations are described in the following paragraphs relativeto the method steps listed above.

[0052] A bone plate may be selected. The bone plate may be preshaped fora particular target bone or bone region, and/or may be shaped/adjustedintraoperatively. The bone plate may have any suitable number ofapertures, including none, one, or more, and the apertures may besimilar in shape and/or size, or may be of two or more different shapesand/or sizes to facilitate tapping intraoperatively and/or to directplacement of bone screws without intraoperative tapping. Aperturesconfigured to be tapped may include a wall region (a land) extendinggenerally orthogonal to a local length-by-width plane defined by thebone plate, such as a wall region forming a cylindrical bore. Acounterbore may be disposed adjacent the wall region so that theaperture flares outward toward the outer surface of the bone plate.

[0053] The bone plate may be positioned on a bone. The bone plate may bedisposed on a surface of the bone and may span a discontinuity in thebone, by extending axially and/or transverse to the bone. For example,FIG. 7 shows an axial sectional view of a bone plate 150 disposed on asurface of a bone 152 having a fracture 154. The plate may be disposedover a region of bone having a cortex 156 and a medullary canal 158and/or may be spaced from the medullary canal of the bone (such asadjacent a metaphyseal region near an end of a bone).

[0054] The bone plate may be connected to the bone. This step ofconnecting may be performed to limit movement of the bone plate relativeto bone during intraoperative tapping and/or subsequent fastenerplacement. Accordingly, the step of connecting may secure the bone plateto the bone so that the bone plate is fixed in position. The step ofconnecting may be performed with one or more fasteners, such as screws,pin, wires, etc., placed through apertures of the bone plate. Forexample, FIG. 7 shows bone plate 150 secured to bone 152 using bonescrews 160 received in apertures 162 that flank an aperture 164 to betapped. Any suitable aperture(s) may be selected for the step ofconnecting. The apertures selected may be tappable intraoperatively (ormay have already been tapped intraoperatively), or may be sized/shapedso that they are not suitable to be tapped intraoperatively.Alternatively, or in addition, the bone plate may be secured with aclamp device, such as that described in Section V.

[0055] The bone plate may have at least one tappable aperture 164. Thetappable aperture may include a generally orthogonal wall or a land 166into which a thread(s) may be formed during intraoperative tapping. Theland may define a lip of the aperture. In the present illustration, wall166 defines a cylindrical region of the aperture. Aperture 164 also oralternatively may include a counterbore 168, such as the radiused orgenerally frustospherical counterbore shown here. Such a counterbore maybe formed, for example, with a balling mill. In the presentillustration, tappable aperture 164 has a distinct configurationrelative to other apertures 162 of the bone plate. Accordingly, tappableapertures may be visibly distinct and/or may be marked with indicia toindicate that they are configured to be tapped. Alternatively, in someembodiments, all the apertures of a bone plate may be similar instructure and configured to be tapped.

[0056] A pilot hole may be formed in the bone. The pilot hole may beformed with a hole-forming tool such as a drill and/or by a tap devicehaving a hole-forming structure. The pilot hole may be formed inalignment with an aperture of the bone plate, for example, generallycentered below the aperture. The pilot hole may be formed orthogonal tothe bone plate or at a selected angle relative to the bone plate. Theangle of the pilot hole may determine a corresponding angle at which abone screw will subsequently engage a newly tapped aperture. This anglethus may be selected by a surgeon during surgery, rather than beingpredetermined as in the case of a pre-threaded aperture. The pilot holemay have a diameter greater than the diameter of a tip portion of thetap device and less than the diameter of a shank of a bone screw to beplaced in to the pilot hole. The pilot hole may have any suitable depthand may extend unicortically, bicortically, and/or into cancellous bone,among others.

[0057]FIG. 8 shows an exemplary configuration produced during a step offorming a pilot hole in the bone. A drill 172 may be drivenrotationally, shown at 174, and advanced axially through tappableaperture 164 to form a pilot hole 178. The drill 172 may be disposed ata selected oblique angle (or orthogonally) relative to the bone surface.The drill 172 may be advanced through the cortex 156 and into themedullary canal 158 (and/or into cancellous bone and/or into/through anopposing cortex). The depth of hole formation may be determined, forexample, by a stop disposed on the drill, by depth indicia on the drillor on a measuring device, by visual observation, and/or the like. Insome examples, the drill may be guided by a guide device, such as ahand-held cannula 180 disposed in engagement with the bone plate aroundthe tappable aperture 164.

[0058] An aperture of the bone plate may be tapped to form a thread inthe aperture. The aperture may be tapped using a tap device. Theaperture may be tapped with the plate positioned away from the bone(such as with the plate disposed on a rack or frame), and/or it may betapped in situ, with the plate positioned adjacent the bone. A tipportion of the tap device may be received in a pilot hole to guide a tapportion of the tap device to an aperture. The tip portion may follow apre-formed pilot hole, may form the pilot hole, and/or may widen thepilot hole. For example, FIG. 9 shows tip portion 42 of tap device 12being advanced axially along pilot hole 178, shown at 182. The tapdevice may be rotated so that the tap portion 46 taps a wall of theaperture and, optionally, underlying bone, particularly cortical bone.The tap device may tap the aperture at least substantiallysymmetrically, for example, evenly tapping the walls of a circularaperture, allowing for up to full threaded engagement of a fastener withthe aperture. Alternatively, the tap device may tap the apertureasymmetrically, for example, tapping an end, and optionally the adjacentsides, of an elongated aperture, leaving the other end, and optionallythe adjacent sides, untapped, allowing for partial threaded engagementof a fastener with the aperture. For example, FIG. 10 shows tap device12 with tap portion 46 in engagement with the bone plate and underlyingcortical bone, to form a thread 184 in aperture 164 and extending intothe bone, shown at 186. Because the tap portion may be tapered, thethread formed in bone may be shallower than in the bone plate. Thereamer portion 44 of the tap device may widen the pilot hole and/or theaperture of the bone, shown at 188. Tapping may be terminated based avisible position of the tap device and/or a marking(s) thereon, using astop mechanism, based on image (such as X-ray) analysis, trial placementof a fastener, and/or the like.

[0059] The tap device may be removed after the aperture has been tapped.For example, FIG. 11 shows a tapped bore 192 formed by the tap device.The tapped bore may include a tapped aperture 194 of the bone plate andtapped bone 196 formed adjacent the tapped aperture. The tapped borealso may narrow distally, shown at 198, as it joins the pilot hole 178.Alternatively, the tap device may be left in position after the aperturehas been taped, for example, when a bone screws taps the aperture of thebone plate.

[0060] A fastener may be placed into the tapped aperture and into thebone. The fastener may be advanced rotationally into the tapped bore andpilot hole, to lock the fastener to the bone plate and to engage bone.For example, FIG. 12 shows bone screw 110 in threaded engagement withtapped aperture 194 and cortical bone 156, through the head 112 of thebone screw. Accordingly, the head may be placed into threaded engagementwith a pre-existing thread in both the bone plate and the bone. Theshank of the bone screw may be in threaded engagement withadjacent/opposing bone, such as the same cortex and/or the opposingcortex of the bone.

[0061] Fasteners then may be placed into other apertures of the boneplate. These fasteners may be placed into intraoperatively tappedapertures and/or into nontapped apertures.

[0062] IV. Bone Plates

[0063] Bone plates for intraoperative tapping generally comprise anyrelatively low-profile (or plate-like) fixation device configured tostabilize at least one bone by attachment to the bone. The fixationdevice may be configured to span any suitable bone discontinuity (ordiscontinuities) so that the fixation device fixes the relativepositions of bone pieces/fragments (and/or bones) disposed on opposingsides of the bone discontinuity (or discontinuities). Alternatively, orin addition, the fixation device may reinforce a bone lacking adiscontinuity.

[0064] Suitable discontinuities may occur naturally and/or may resultfrom injury, disease, and/or surgical intervention, among others.Accordingly, exemplary discontinuities for use with the fixation devicesdescribed herein may include joints, fractures (breaks in bones),osteotomies (cuts in bones), and/or nonunions (for example, produced byinjury, disease, or a birth defect), among others.

[0065] The bone plates to be tapped intraoperatively may be configuredfor use on any suitable bone, in any suitable species, including human,equine, canine, and/or feline species, among others. Exemplary bones mayinclude bones of the arms (radius, ulna, humerus), legs (femur, tibia,fibula, patella), hands/wrists (e.g., phalanges, metacarpals, andcarpals), feet/ankles (e.g., phalanges, metatarsals, and tarsals),vertebrae, scapulas, pelvic bones, cranial bones, ribs, and/orclavicles, among others.

[0066] Each bone plate may be configured to be disposed in any suitableposition relative to its target bone. The bone plate (or a plateportion) may be configured to be disposed in contact with an exteriorsurface of the bone and thus may be positioned at least substantially(or completely) exterior to the bone. Alternatively, the bone plate maybe configured to be disposed at least partially interior to a bone, thatis, apposed to (normally) interior bone surfaces when secured to thebone. The interior surfaces of the bone may be accessed duringinstallation of the bone plate (such as by punching the bone platethrough the exterior bone surface) and/or may be accessible due to abreak, a cut, and/or the like.

[0067] The bone plates may be formed of any suitable material(s). Thebone plates may be of a sturdy yet malleable construction. Generally,the bone plates should be stiffer and stronger than the section of bonespanned by the plates, yet flexible (e.g., springy) enough not to strainthe bone significantly. Suitable materials for forming the bone platesmay include metal, polymer, plastic, ceramic, composite, and/or thelike. Suitable materials may include biocompatible materials. Exemplarybiocompatible materials may include metals/metal alloys (for example,titanium or titanium alloys; alloys with cobalt, chromium, and/ormolybdenum; stainless steel; etc.) and/or bioresorbable materials (suchas polygalactic acid (PGA), polylactic acid (PLA), polycaprolactones,polydioxanones, copolymers thereof, etc.), among others. The materialsmay be specially selected and/or treated (e.g., by annealing) tofacilitate tapping, for example, being softer than at least the cuttingportion of the tap, and potentially being softer than regular boneplates (although still hard enough to perform the desired function).

[0068] The bone plates may be configured to reduce irritation to thebone and surrounding tissue. For example, the bone plates may be formedof a biocompatible material, as described above. In addition, the boneplates may have a low and/or feathered profile to reduce theirprotrusion into adjacent tissue and rounded, burr-free surfaces toreduce the effects of such protrusion.

[0069] The bone plates described herein may be sized and shaped toconform to particular portions of a bone (or bones). The plates may begenerally elongate, with a length L, a width W, and a thickness T. Here,length L≧width W>thickness T. In use, the long axis of the bone plates(or of a plate portion) may be aligned with the long axis of thecorresponding bone, and/or may extend obliquely and/or transverselyrelative to the bone's long axis. The length and/or width of the boneplates may be varied according to the intended use, for example, tomatch the plates with a preselected region of bone(s) and/or aparticular injury to the bone. For example, the plates may be generallylinear for use on the shaft of a long bone and/or may have a nonlinearshape, such as for use near an end of a bone and/or for transverseplacement on the shaft, among others. In some examples, the plates maybe configured to wrap at least partially around a bone, so that portionsof each plate are disposed on distinct sides and/or generally opposingsides/surfaces of a bone. In some embodiments, the bone plates may beconfigured for use on both sides of the body/skeleton, such as when thebone plates are bilaterally symmetrical. In some embodiments, the boneplates may be asymmetrical and configured for use on either the left orthe right side of the body/skeleton.

[0070] The bone plates may include inner (bone-facing) and outer(bone-opposing) surfaces. One or both of these surfaces may be contouredgenerally to follow an exterior surface of a target bone (or bones) forwhich a bone plate is intended, so that the bone plate maintains a lowprofile and fits onto the bone(s). For example, the inner surface of aplate may be generally complementary in contour to the bone surface. Theouter surface of the plate also may correspond in contour to the bonesurface and may be generally complementary to the inner surface of theplate. The bone plates may be partially and/or completely precontoured,at the time of manufacture, allowing practitioners to apply them tobone(s) with little or no additional bending at the time of application.Preshaping the plates allows the inner or bone-facing surface of theplate to follow and substantially match the three-dimensional contour ofa bone, along the length of the plate and/or across the width of theplate. For example, the plates may include curved, bent, twisted, and/ortubular inner surfaces that are adapted to face bone and to guide theplates to set onto the bones, initially to enhance fixation and/or totemplate reduction of bone, and subsequently to increase stability, bygrabbing and holding bone fragments. In some embodiments, the plates maybe somewhat undercontoured along their long axes, for example, toaccommodate soft tissue between a portion of the plate and the bone, orto allow additional custom contouring pre- or intraoperatively, amongothers. Alternatively, or in addition, the bone plates may becustom-contoured by practitioners before and/or during installation ontobone.

[0071] The thickness of the bone plates may be defined by the distancebetween the inner and outer surfaces of the plates. The thickness of theplates may vary between plates and/or within the plates, according tothe intended use. For example, thinner plates may be configured for useon smaller bones and/or on bones or bone regions where soft tissueirritation is a greater concern. Thickness may be varied within theplates. For example, the plates may become thinner as they extend overprotrusions (such as processes, condyles, tuberosities, and/or thelike), reducing their profile and/or rigidity, among others.Alternatively, or in addition, the thickness may vary as an interiorportion of the bone plate extends into bone, for example, becomingthinner to facilitate insertion of this interior portion or thicker toincrease structural stability. The thickness of the plates also may bevaried to facilitate use, for example, to make the plates thinner wherethey typically need to be deformed by bending and/or twisting theplates, such as at a junction (or bridge region) between plate portions.In this way, the plates may be thicker and thus stronger in regionswhere they may not need to be contoured, such as along the shaft of thebone.

[0072] The bone plates generally include a plurality of openings(apertures). The openings may be adapted to receive fasteners forsecuring the plates to bone. Alternatively, or in addition, one or moreof the openings may be configured to alter the local rigidity of theplates, to permit the plates to be manipulated with a tool (such as anattachable handle), to facilitate blood flow to bone regions where thebone plates are installed, to promote healing, and/or the like. Theseopenings may extend through the bone plates (between inner and outersurfaces) and/or may extend at least substantially parallel to the innerand/or outer surfaces of the bone plates.

[0073] The openings may have any suitable positions, sizes, and/ordensities within each portion of a bone plate. The openings may bearrayed generally in a line along a portion of the plate, for example,centered across the width of the plate. Alternatively, the openings maybe arranged nonlinearly, for example, disposed in an arcuate, staggered,or other two-dimensional (or three-dimensional) arrangement.

[0074] The openings may have any suitable shape and structure. Exemplaryshapes may include circular, elongate (such as elliptical, rectangular,oval), etc. The openings may include counterbores. The counterbores maybe configured, for example, to receive a head of a bone screw, to reduceor eliminate protrusion of the head above the outer surface of theplate. The openings may be threaded or nonthreaded, and each bone platemay include one or more threaded and/or nonthreaded openings. Threadedopenings may be used to position at least a portion of a bone plate awayfrom the bone, as described above, so that the periosteum, neurovascularbodies, and the like, may pass under the plate without being pinched ordamaged.

[0075] Openings to be tapped (tappable apertures) may have any suitableshape and structure. Tappable apertures may be round, elliptical, oval,and/or the like. Tappable apertures may include a lip (a land) having aWall extending generally parallel to a thickness axis of the plate. Thelip may be disposed adjacent the inner (bone-facing) surface of the boneplate (and spaced from the outer surface of the bone plate).Accordingly, with a circular tappable aperture, the lip or land maydefine a cylindrical region of the aperture to be tapped. Tappableapertures may include or lack a counterbore, generally disposed adjacentthe outer (bone-opposing) surface of the bone plate (and spaced from theinner surface of the bone plate). The counterbore may have any suitableshape including frustoconical, radiused (such as a generallyfrustospherical), and/or a combination thereof, among others. In someexamples, a concave radiused (such as frustospherical) counterbore maybe preferred over a frustoconical counterbore, because a thread may beformed by removing less material from the bone plate duringintraoperative tapping.

[0076] In some embodiments, the plates may include one or a plurality ofelongate openings (for example, oval openings) extending axially,obliquely, and/or transversely within each bone plate. The elongateopenings may be compression slots that include tapered counterbores toprovide compression when heads of bone screws are advanced against thecounterbores. Alternatively, or in addition, the elongate openings maybe used to adjust the position of bone plates and/or plate portionsrelative to bone before the plates are fully secured to the bone. Insome examples, some or all of the elongate openings may be configured tobe tapped intraoperatively, as discussed above. In other examples, someor all of the elongate openings may not be configured to be tappedintraoperatively, whereas at least one or more circular openings in thebone plate may be configured to be tapped intraoperatively.

[0077] In some examples, the bone plates may include one or moreprojections. The projections may extend, for example, generallyorthogonal from the inner surface of the bone plates toward bone. Theprojections may be sharp or blunt according to their intended use. Forexamples, sharp projections may be configured as prongs that penetratebone to restrict movement of the bone plates. Prongs may be used inplace of, or in addition to, bone fasteners, for one or more portions ofeach bone plate. Blunt (or sharp) projections, such as ridges or knobs,may be configured as spacing members that elevate the bone plates fromthe bone surface.

[0078] The bone plates may have at least one, and generally two or more,plate portions (or anchor portions) configured to be secured todifferent regions of a bone (or bones). Each plate portion may bestructured for a specific region of a bone. For example, the bone platesmay include a proximal plate portion for attachment to a more proximalregion of a bone, and a distal plate portion for attachment to a moredistal region of the same bone. Alternatively, or in addition, the boneplates may include an exterior plate portion configured to fit againstan exterior surface region of bone adjacent a bone discontinuity, and/oran interior plate portion configured to be received in an interior(e.g., recessed, resected, and/or excavated) region of bone adjacent thebone discontinuity.

[0079] The plate portions of a bone plate may have any suitableconnection. In some examples, the plate portions may be formedintegrally, so that one piece of the bone plate includes the plateportions. Alternatively, plate portions may be formed as separatepieces. The separate pieces may be connected by any suitable connectionand/or joint, including a fastener(s), welding, a hinge joint, aball-in-socket joint, and/or the like. Further aspects of bone plateshaving adjustable joints are described in the following patentapplication, which is incorporated herein by reference: U.S. patentapplication Ser. No. 10/716,719, filed Nov. 19, 2003.

[0080] The plate portions of a bone plate may have any suitable relativedisposition. The plate portions may be disposed such that they aresubstantially collinear and/or parallel, oblique, or substantiallytransverse to one another. The relative disposition may be fixed and/oradjustable. In some examples, the plate portions may be connectedintegrally by a deformable bridge region, so that the bone plate can bebent pre- or intraoperatively to adjust the relative disposition of theplate portions. Alternatively, the plate portions may be distinct piecesconnected, for example, through an adjustable joint, as described above.

[0081] V. Guide Devices

[0082] The systems of the present teachings may include one or moreguide devices. A guide device may include any structure, other than thebone plate or bone, that guides hole formation in bone (and/or in thebone plate), thread formation in the bone plate (and/or bone), and/orfastener placement.

[0083] The guide device may form a channel along which a fastener, a tapdevice, a reamer, and/or a drill may be guided. The channel may have anysuitable structure, such as linear or nonlinear. The channel may begenerally cylindrical or noncylindrical. The channel may be hollow (suchas a tube with an axial bore) and/or may be solid (such as a guidewire).

[0084] The guide device may be held in position during its use by anysuitable mechanism. For example, the guide device may be held manually,such as through a handle and/or other graspable portion. Alternatively,or in addition, the guide device may be held with an auxiliary device,such as a positioning jig, and/or it may be secured directly to the boneplate and/or bone, such as with a fastener(s), a clamp, and/or the like.

[0085]FIG. 13 shows an exemplary guide device 210 clamped to a bone 212and a bone plate 214. The guide device may define a path 216 through anaperture 218 of the bone plate and into the bone. The path may bedefined between positions of opposing engagement of the guide devicewith bone and/or the bone plate. The guide device may include a frame220 that holds or includes a clamp portion 222, a clamp releasemechanism 224, a guide portion 226, and a handle portion 228.

[0086] The clamp portion 222 may be configured to apply a compressiveforce to the bone plate and the bone. The compressive force may restrictslippage of the clamp device and/or the bone plate. The clamp portionmay include a pincer formed by opposing (first and second) pincermembers 230, 232. First pincer member 230 may be included in an arm 234extending from the frame 220 to an opposing surface of the bone. Thefirst pincer member may indicate a location where a pilot hole, tapdevice, and/or fastener would exit the bone opposite the plate. Thus,the first pincer member may serve as an indicator that shows the linearextension from the guide portion, along path 216, through the bone. Thismay enable a surgeon to choose more precisely a suitable angle at whichin to form a pilot hole, tap the bone plate, and/or place a fastener.Second pincer member 232 may be threadably coupled to the frame, so thatrotation of the second pincer member adjusts the spacing between thepincer members, and thus how tightly the bone and bone plate areengaged.

[0087] The clamp release mechanism 224 may include a threaded block orretainer 238 biased into threaded engagement with the second pincermember 232. The retainer may be biased with a biasing mechanism 240including a spring 242 or other biasing element. A switch, such as alever or trigger 244, may be coupled to the biasing mechanism 240, andmay be operable to release second pincer member 232 from engagement withretainer 238, to allow release and/or repositioning of the clampportion.

[0088] Guide portion 226 may be formed at least partially by the secondpincer member 232. The guide portion 226 may include an axial bore 246sized to receive a drill, a tap device, and/or a fastener, among others.

[0089] VI. Kits

[0090] The systems of the present teachings may provide kits for tappingapertures intraoperatively. These kits may include (1) one or more tapdevices, (2) one or more bone plates, (3) fasteners such as bone screws,(4) a guide device, and/or (5) instructions for their use, among others.

[0091] The kits may include one or more tap devices. Tap devicesincluded in a kit may be of various sizes, including tap devices withdifferent lengths, diameters, thread pitches, and/or thread depths, tobe used in conjunction with various bone plates and/or fasteners forfixation of various types of fractures. For example, the tap devices mayhave tap portions of various lengths to accommodate bone plates ofdifferent thicknesses, and they may have tap portions of variousdiameters to accommodate bone plate apertures of different sizes. Thetap devices in a kit also may have tap portions of various threadpatterns, to tap apertures for engaging various sizes/types of bonescrews. The tap devices also may have tip portions of different lengthsand/or diameters, to follow and/or form pilot holes of different depthsand/or diameters, for example, according to the length and/or diameterof bone screws to be placed into the tapped apertures. A kit may includea plurality of interchangeable tap portions and/or a plurality ofinterchangeable tip portions, to accommodate various combinations ofbone plate thickness, aperture diameter, thread pattern, pilot holediameter, and/or pilot hole depth, among others.

[0092] Bone plates provided in kits (or selected otherwise) may be sizedand/or shaped to conform to particular regions of bone, or to differentportions of the same region of bone, among others. In particular, theplates may be preshaped (preformed) to fit an average target anatomy,such as a population-averaged shape of a particular anatomical region.The average anatomy may be a human (or other animal) anatomy averagedover any suitable set, such as, for example, adults, adult males, adultfemales, people that fall within a particular size range, children of agiven age, and so on. The bone plates may include one or more apertures,such as one or more circular and/or oval apertures. In some examples,the kits may include at least one bone plate having a circular aperturecorresponding generally in diameter to the root-to-root diameter of atap portion of a tap device in the kits.

[0093] Fasteners, such as bone screws, provided in kits (or selectedotherwise) may be sized and/or shaped in correspondence with one or moretap devices included in the kits. For example, the kits may include bonescrews with a head configured to be threadably engaged with a threadformed by a tap device of the kit, and/or with a shank configured to bethreadably engaged with bone surrounding a pilot hole formed and/orfollowed by the tap device. The kits also may include one or moreadditional fasteners configured to be placed into bone from nonthreadedapertures of the bone plates.

[0094] The kits also may include additional tools and/or consumablesurgical supplies that may be required for carrying out the connectivetissue repair, substantially as described above, such as additionalclamps and/or other surgical tools that may facilitate grasping and/orpositioning the connective tissue that is being repaired.

[0095] The kits may be constructed or assembled for single and/ormultiple use. For example, the kits, or components thereof, may beconfigured, in some embodiments, for a single use, such as tapping asingle aperture, a single plate, or a set of plates during a singlesurgical procedure. These embodiments optionally may be prepackaged in asterile wrapper. Thus, as needed, components of the kit could be removedfrom the sterile wrapper, used to tap and install one or more plates,and then discarded. Alternatively, the kits, or components thereof, maybe configured, in other embodiments, for effecting multiple repairs,during the same or different surgical procedures. In these cases,reusable components may be configured to reduce contamination (e.g., viasmooth surfaces) and/or to facilitate sterilization, such as by washingand autoclaving (e.g., through choice of material, such as metal).

VII. EXAMPLES

[0096] The following examples describe selected aspects and embodimentsof the present teachings, as a series of ordered paragraphs. Theseexamples are included for illustration and are not intended to limit ordefine the entire scope of the invention.

[0097] 1. A kit for internally fixing a discontinuity in a bone,comprising: a drill tap, including (1) a tapping portion including aplurality of external threads configured to intraoperatively forminternal threads in the aperture of a bone plate; and (2) a guidancetip, attached to the tapping portion, configured to follow and/or form apilot hole in a bone.

[0098] 2. The kit of paragraph 1, wherein the guidance tip is detachablefrom the tapping portion.

[0099] 3. The kit of paragraph 1, wherein the drill tap furthercomprises a shaft portion adapted to engage with a turning mechanism.

[0100] 4. The kit of paragraph 1, wherein the drill tap furthercomprises a tapered portion, disposed between the tapping portion andthe guidance tip, for forming a tapered region of the pilot hole.

[0101] 5. The kit of paragraph 1, further comprising:

[0102] a clamp guide, including a bone clamp portion for holding thebone plate to the bone; and a drill guide portion configured to providealignment for the drill tap.

[0103] 6. The kit of paragraph 5, wherein the clamp guide furthercomprises an indicator configured to indicate a linear extension of thedrill tap through the bone.

[0104] 7. The kit of paragraph 5, further comprising a bone plate havingat least one threadable aperture.

[0105] 8. The kit of paragraph 1, further comprising a bone plate havingat least one threadable aperture.

[0106] 9. A method of internally fixing a discontinuity in a bone,comprising: (1) selecting a bone plate having at least one threadableaperture; (2) positioning the plate on a surface of the fractured bone;(3) threading intraoperatively at least one of the threadable apertures;and (4) attaching the plate to the bone by inserting a threaded fastenerinto one or more of the intraoperatively threaded apertures.

[0107] 10. The method of paragraph 9, the threaded fastener being a bonescrew, wherein threads of the bone screw engage threads of the aperture.

[0108] 11. The method of paragraph 10, further comprising drilling apilot hole in the bone for engaging a shaft portion of the bone screw.

[0109] 12. The method of paragraph 11, wherein the steps of drilling apilot hole and intraoperatively threading at least one of the threadableapertures are performed sequentially.

[0110] 13. The method of paragraph 11, wherein the steps of drilling apilot hole and intraoperatively threading at least one of the threadableapertures are performed at least partially simultaneously.

[0111] 14. The method of paragraph 13, wherein the steps of drilling apilot hole and intraoperatively threading at least one of the threadableapertures are performed by a drill tap comprising: (1) a tapping portionincluding a plurality of external threads configured to form internalthreads in the aperture of a bone plate; and (2) a guidance tip, rigidlyattached to the tapping portion, configured to follow and/or form apilot hole in a bone.

[0112] 15. The method of paragraph 9, further comprising clamping thebone plate to the bone, prior to the step of intraoperatively threading.

[0113] 16. The method of paragraph 15, further comprising selecting anangle for threading the threadable aperture.

[0114] 17. The method of paragraph 16, further comprising aligning adrill tap at the selected angle with a clamp guide.

[0115] 18. The method of paragraph 9, wherein the step ofintraoperatively threading at least one of the threadable aperturescomprises: (1) tapping the at least one of the threadable apertures tocreate threads using a drill tap; and (2) removing the drill tap fromthe at least one of the threadable apertures, so that the aperture isaccessible to a fastener.

[0116] The disclosure set forth above may encompass multiple distinctinventions with independent utility. Although each of these inventionshas been disclosed in its preferred form(s), the specific embodimentsthereof as disclosed and illustrated herein are not to be considered ina limiting sense, because numerous variations are possible. The subjectmatter of the inventions includes all novel and nonobvious combinationsand subcombinations of the various elements, features, functions, and/orproperties disclosed herein. The following claims particularly point outcertain combinations and subcombinations regarded as novel andnonobvious. Inventions embodied in other combinations andsubcombinations of features, functions, elements, and/or properties maybe claimed in applications claiming priority from this or a relatedapplication. Such claims, whether directed to a different invention orto the same invention, and whether broader, narrower, equal, ordifferent in scope to the original claims, also are regarded as includedwithin the subject matter of the inventions of the present disclosure.

I claim:
 1. A method of tapping a bone plate intraoperatively,comprising: selecting a bone plate having an aperture; placing the boneplate on a bone; and forming a thread in the aperture with the boneplate disposed on the bone.
 2. The method of claim 1, wherein the stepof placing includes a step of attaching the bone plate to the bone. 3.The method of claim 2, the aperture being a first aperture, wherein thestep of attaching includes a step of inserting a fastener through asecond aperture and into the bone.
 4. The method of claim 1, wherein thestep of forming also forms a thread in the bone.
 5. The method of claim1, further comprising a step of forming a hole in the bone, the holebeing in alignment with the aperture.
 6. The method of claim 5, whereinthe step of forming a hole is performed at least substantially beforethe step of forming a thread.
 7. The method of claim 6, wherein the stepof forming a thread is performed with a tap device having a tap portionand a tip portion, and wherein the step of forming a thread includes astep of inserting the tip portion into the hole so that the tap portionis guided to the aperture.
 8. The method of claim 5, further comprisinga step of widening the hole adjacent the aperture to create acounterbore in the bone, wherein the step of widening is performed atleast partially during the step of forming a thread.
 9. The method ofclaim 1, further comprising a step of selecting an angle for the step offorming a thread.
 10. The method of claim 9, Wherein the step ofselecting an angle includes a step of disposing a guide device at leastsubstantially at the angle.
 11. The method of claim 9, wherein the stepof selecting an angle includes a step of drilling a hole in the bone atleast substantially at the angle.
 12. The method of claim 1, furthercomprising a step of placing a fastener through the aperture and intothe bone after the step of forming a thread in the aperture.
 13. Themethod of claim 12, wherein the step of forming a thread is performedusing a tap device, the method further comprising a step of removing thetap device from the aperture after the step of forming a thread so thatthe aperture is accessible to the fastener.
 14. The method of claim 1,wherein the step of selecting a bone plate includes selecting a boneplate formed at least substantially of metal.
 15. The method of claim14, wherein the step of selecting a bone plate includes selecting a boneplate formed at least substantially of titanium.
 16. A method of fixinga bone, comprising: selecting a bone plate having a plurality ofapertures; securing the bone plate to the bone with at least one firstfastener placed into the bone from at least one first aperture of thebone plate; forming a thread in a second aperture of the bone plateafter the step of securing; and placing a second fastener through thesecond aperture, into bone, and into threaded engagement with thethread.
 17. A device for tapping a bone plate intraoperatively,comprising: a tap portion configured to form a thread in an aperture ofa bone plate connected to a bone as the tap portion is rotated; and atip portion attached to the tap portion and configured to follow a holein the bone to guide the tap portion to the aperture.
 18. The device ofclaim 17, wherein the tip portion also is configured to form the hole inthe bone.
 19. The device of claim 17, wherein the tip portion is longerthan the tap portion.
 20. The device of claim 17, further comprising areamer portion disposed between the tap portion and the tip portion, thereamer portion being configured to widen the hole in the bone.
 21. Thedevice of claim 17, wherein the tap portion tapers toward to the tipportion so that the thread formed by the tap portion varies in depth.22. The device of claim 17, wherein the tip portion is at leastsubstantially nonthreaded.
 23. The device of claim 17, furthercomprising shaft attached to the tap portion and opposing the tipportion.
 24. A kit for tapping a bone plate, comprising: a bone platehaving an aperture; and a tap device configured to form a thread in theaperture.
 25. The kit of claim 24, further comprising a plurality ofbone screws, at least one of the bone screws being configured to bereceived in the aperture, in threaded engagement with the thread. 26.The kit of claim 25, the bone plate having a thickness, wherein the oneor more bone screws include a threaded head region, and wherein thethreaded head region has an axial length that is substantially greaterthan the thickness of the bone plate.